Vitiligo Treatment

Overview

Vitiligo - Stem Cell Therapy in India

Vitiligo is a chronic condition that causes pale, white patches to develop on the skin. The areas affected have little or no melanin.

Melanin is a dye-like substance that is produced by specialised skin cells called melanocytes, which give your skin its colour and protect it from the sun's rays.

Where does vitiligo occur?

Vitiligo can affect any area of your skin, but most commonly occurs on skin that is exposed to the sun, such as your face, neck and hands.

Vitiligo is more noticeable in people whose skin is dark or tanned. The condition varies from person to person. For example, some people only get a few small, white patches that progress no further. Other people get bigger white patches that join up across large areas of their skin.

There is no way of predicting how much of your skin will be affected, and the white patches are usually permanent.

Who is affected by vitiligo?

In the UK, about one in 100 people develop vitiligo. In about half of all cases it begins before the age of 20, although it can occur at any age. Both men and women are equally affected.

It is not clear what causes vitiligo. It is not infectious and you can't catch it from contact with an affected person.

Symptoms of vitiligo

The main symptom of vitiligo is flat, white spots or patches on your skin. The first white patch usually develops where the skin has been exposed to the sun.

Vitiligo does not cause physical discomfort to your skin, such as itching.

Areas commonly affected by vitiligo

The areas most commonly affected by vitiligo include : -

The face and neck

Hand

Genitals

The symptoms of vitiligo often appear on both sides of your body as symmetrical white patches. This is sometimes called bilateral, or generalised, vitiligo. Symmetrical patches can appear on areas such as : -

The backs of your hands

Your arms

Eyes

Knees

Elbows

Feet

Sometimes, vitiligo can develop on your scalp. The lack of melanin in your skin can cause the hair in the affected area to turn white or grey.

If you have vitiligo, you may get a rash after you have been in the sun (photosensitivity).

Sometimes the white patches may only affect one area of your body. This is known as unilateral, localised or segmental vitiligo. Unilateral vitiligo is less common than bilateral vitiligo although, in children, the symptoms of vitiligo usually affect only one part of the body.

In rare cases, it is possible for vitiligo to affect your whole body. This is known as universal, or complete, vitiligo.

How do symptoms of vitiligo develop?

If you have vitiligo, it is difficult to predict whether your condition will spread from the original patch, or how fast it may spread. It is likely that more white patches will appear. For some people this can happen quickly, while for others the patches may stay the same for months or years.

If the white patches appear symmetrically on more than one part of your body, the condition may progress quite slowly, with periods when the patches don't change. If you have white patches on only one area of your body, the condition may progress more rapidly.

Causes of vitiligo

Your skin gets its colour from a pigment called melanin, which is produced by your skin cells (melanocytes).

If you have vitiligo, some of your skin cells do not produce enough melanin, causing white patches to develop on your skin.

Vitiligo is not caused by an infection.

Autoimmune conditions

Although its cause is not fully understood, vitiligo is thought to be an autoimmune condition. This means that your immune system does not work properly.

Instead of attacking foreign cells, such as bacteria, your immune system produces antibodies that attack your body's own healthy cells and tissue.

If you have vitiligo, it's thought your immune system produces antibodies which destroy skin cells that make melanin.

Vitiligo can be associated with other autoimmune conditions, such as hyperthyroidism (an overactive thyroid gland). See the Complications section for more information about this.

Occupational vitiligo

In a susceptible person, exposure to certain chemicals (in your job for example), could cause a reaction, and lead to white patches developing on your skin. This is sometimes called occupational, or contact, vitiligo.

Other causes

Vitiligo can run in families. About one in three people who have vitiligo also have a relative who is affected by the condition.

Sometimes vitiligo can be caused by severe sunburn.

Diagnosing vitiligo

Tests are not usually needed to diagnose vitiligo. Your GP should be able to identify vitiligo by its appearance. An ultraviolet lamp may be used to highlight any differences in the colour of your skin.

Your GP may ask you : -

if there is a history of vitiligo in your family, and

if you have had sunburn, or a severe rash, on the affected area of skin.

Your GP may also ask you about the impact that vitiligo has on your life. For example : -

how much it affects your confidence and self-esteem, and

whether it affects you in your job.

Treating vitiligo

There is no known cure for vitiligo. However, treatment may help to improve your skin's appearance by : -

restoring pigment, or colour, to your skin, and

helping to control the spread of the condition.

Treatment for vitiligo is not always successful. See the Complications section for more information about this.

Treatment from your GP

If you have new white patches on your skin that do not cover a large area, your GP may prescribe a corticosteroid (steroid) cream. This can sometimes stop the spread of the patches, and may restore your original skin colour.

Your GP will tell you how to apply the cream to the patches and how much you should apply.

The strength of the steroid cream may vary, depending on where your white patches are.

For exam0ple, your GP may prescribe : -

a mild cream for patches on your face, or

a stronger cream for patches on your upper body, arms or legs.

Initially, your GP may advise you to use the cream for between four to six weeks. Steroid cream should only be used for a limited time because long-term use may cause side effects such as:

streaks, or lines, in your skin (striae), or

thinning of your skin (atrophy).

Monitoring the progress of your treatment

Your GP will review the progress of your treatment regularly. They may ask to see you every six weeks in order to monitor your progress.

To assess whether your vitiligo is improving your GP may : -

use a special ultraviolet lamp to examine your skin, or

take photographs of your skin.

If your treatment is working and you don't have any side effects, your GP may recommend taking a break and then continuing with your treatment.

For example, they may suggest that you have a break from treatment for four weeks, then continue with another course of treatment for four weeks. Your progress will be reviewed again after this period.

Protection from the sun

When your skin is exposed to sunlight, it produces a pigment called melanin to help protect it from ultraviolet light.

If you have vitiligo, sunburn is a real risk because of the lack of melanin in your skin. Always apply a high factor sun cream, with sun protection factor (SPF) 30 or above, to protect your skin from sunburn and long-term damage. This is particularly important if you have fair skin.

Protecting your skin from the sun will also minimise tanning, which will help to make your vitiligo much less noticeable.

Referral to a specialist

If the white patches are on visible parts of your body, such as your face, your GP will probably refer you to a skin-care clinic or specialist for advice about skin camouflage.

Your GP may also refer you to a skin specialist (dermatologist) if, for example : -

treatment with steroids has been unsuccessful,

the white patches cover a large area of your body, or

the white patches cover the whole of your body (universal vitiligo), which is rare.

Your specialist may consider other types of treatment, such as those described below.

Skin camouflage

Skin camouflage involves applying coloured creams to your skin to help the white patches blend with the rest of your skin. The creams match your skin's natural colour. For advice about skin camouflage, your GP may refer you to:

a specialist in skin conditions (dermatologist),

a dermatology clinic,

You can also get skin camouflage cream that includes sun block, or sun protection factor (SPF).

Self-tanning lotion (fake tan) may also help to cover vitiligo. Some types can last for several days before you need to reapply them. Self-tanning lotion is available from most pharmacies.

Light therapy (phototherapy)

Treatment with light therapy may be used if the white patches cover a large part of your body. In almost half of all cases of vitiligo, light therapy works well and returns the original colour to the skin.

During light therapy, your skin is exposed to ultraviolet A (UVA) light from a special lamp, after you have had a medicine (psoralen) that makes your skin more sensitive to the light. You can take the medicine by mouth (orally), or you can add it to your bath water. This type of treatment is sometimes called PUVA (psoralen and ultraviolet A light).

PUVA can increase the risk of skin cancer because of the extra exposure to UVA rays. Therefore, it is not recommended for children or pregnant women.

Ultraviolet B (UVB) light is also sometimes used in light therapy.

Depigmentation

Doctors may recommend depigmentation for people who have vitiligo on more than 50% of their bodies.

During depigmentation, the unaffected skin is faded in order to remove its colour (pigment) and match the white areas. A special medicine is applied to the white patches twice a day, for a year. Depigmentation is permanent and cannot be reversed.

Skin grafting

Your doctor may consider using skin grafts if the white patches have stopped developing. This type of treatment is time consuming. It is not always successful, and has a risk of scarring.

During a skin graft, a surgeon will remove a thin layer of normal skin from one area of your body and attach it to the white area.

Other treatments

Sometimes, your doctor may recommend trying more than one treatment. For example, calcipotriol cream is sometimes used alongside light therapy, and tacrolimus or pimecrolimus creams are sometimes used with laser therapy.

Stem Cell Therapy in India

Stem cells are the master cells of the human body. They can divide to produce copies of themselves and many other types of cell. They are found in various parts of the human body at every stage of development from embryo to adult.

Because stem cells are so versatile, they could potentially be used to repair and replace damaged human tissue. The purpose of experimental stem cell therapy is to offer potential benefits of stem cells, which may be:

To slow down or stop further deterioration caused by the disease

To see if stem cells can reverse the effects of the disease

This procedure is considered experimental as it is being tested in clinical research studies, and is not yet available as a standard medical treatment.

The stem cells used in our experimental therapy are Mesenchymal stem cells, which are derived from your own bone marrow. These are multipotent stem cells that can transform into a variety of cell types, and thereby help in regeneration and repair of the diseased tissues.

Vitiligo Stem Cell Therapy in India

The goal of therapy in vitiligo is to regenerate the damaged colour producing cells of the skin (melanocytes) and to correct the aberrant immune system. Normally, in vitiligo, the body's own immune system attacks and damages the colour producing cells of skin, hence it is considered as an autoimmune disease. Mesenchymal stem cells have been found to have Immunomodulatory and immunosuppressive properties. Administration of mesenchymal stem cells in vitiligo will prevent further damage to melanocytes and reduce progression of disease. In unstable vitiligo, if stabilization can be achieved other therapies like surgery can be used for further management.

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